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Chapter 28 Kidney Disorders

Age-related changes in kidney function Increased resistance to ADH Kidneys less able to concentrate urine Potassium excretion decreased
Symptoms of pt with renal tumor - Often asymptomatic - Gross hematuria - Flank pain - Palpable abdominal mass
Systemic manifestation of renal tumor - Fever without infection - Fatigue - Weight loss
Kidney Cancer (Renal Cell Carcinoma) - Most common type of kidney cancer
Systemic effects of Renal Cell Carcinoma - Anemia - Erythrocytosis - Hypercalcemia - Liver dysfunction w/elevated liver enzymes
Kidney cancer often occurs in which age of patients? 55-60 years of age
Major concern for surgical treatment of kidney cancer Blood loss during and after surgery
Monitor post surgical kidney cancer patients for Hemorrhage and adrenal insufficiency
What is used for targeted therapy in renal cell carcinoma? Nexavar and Torisel
Kidney Failure Kidneys unable to effectively remove accumulated metabolites from the blood
Kidney Failure Leads to altered fluid, electrolyte and acid-base balance
Renal replacement therapy Hemodialysis Peritoneal dialysis
Intermittent hemodialysis Blood taken from patient and pumped to dialyzer (ultrafiltration)
Complications of intermittent hemodialysis Hypotension, bleeding and infection
Nonsurgical management of kidney cancer Radiofrequency ablation can slot tumor growth
Kidney cancer Chemo has limited effectiveness against this cancer type
Nonsurgical management of kidney cancer Interleukin-2 and tumor necrosis factor (TNF) lengthens survival times
Interleukin-2 Protein that regulates the activities of white blood cells that are responsible for immunity
Tumor necrosis factor (TNF) Superfamily of cytokines that can cause cell death
Cytokines Any of a number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells of the immune system and have an effect on other cells
Nexavar (Sorafenib) Used to treat kidney, liver, and thyroid cancer. (Chemotherapy medication)
Torisel (Temsirolimus) Used to treat advanced kidney cancer. (Chemotherapy medication)
Complications of surgical procedure for kidney cancer Decreased blood pressure
Diagnostic tests for kidney cancer - Renal ultrasonography - CT scan - Chest x-ray, bone scan, MRI, liver function studies
Continuous renal replacement therapy (hemodialysis) - Porous hemofilter for 8-12 hrs - CVVH - Continuous venovenous hemofiltration - CVVHD - Continuous venovenous hemodialysis - CVVHDF - Continuous venovenous hemodiafiltration
Long-term vascular access devices for hemodialysis - Ateriovenous fistula (AVF) - Ateriovenous graft
Temporary vascular access devices for hemodialysis - Hemodialysis catheter (dual/triple lumen) - Ateriovenous shunt
Complications of access devices - Thromboses - Clotting of AV access - Graft fail
Most common type of peritoneal dialysis - CAPD (Continuous ambulatory peritoneal dialysis) - CCPD (Continuous cycling peritoneal dialysis)
CAPD Not attached to pt. Pt able to ambulate.
CCPD Pt attached to cycler at night while sleeping. Exchange takes 8-10 hours.
CAPD or CCPD Less effective but more continuous metabolic clearance (avoids fluctuations)
Complications of peritoneal dialysis - Peritonitis - Body image disturbance
Chronic Kidney Disease Prevalent among people 65 and older
Pathophysiology of Chronic Kidney Disease - Glomerulosclerosis; hardening of the glomerulus in the kidney - Interstitial inflammation: swelling between the kidney tubules - Fibrosis: thickening and scarring of connective tissue
Chronic Renal/Kidney Disease - Gradual irreversible kidney damage and loss of function - Eventually unable to function adequately, leading to ESRD
Leading cause of End-Stage Renal Disease (ESRD) Diabetes
Stages of Chronic Kidney Disease (CKD) - Decreased renal reserve - Renal insufficiency - Renal failure - ESRD
Early-stage CKD manifestations - Proteinuria, hematuria, polyuria, nocturia - Dehydration - Fixed specific gravity: SG of 1.010 regardless of fluid intake
Manifestations of CKD - Uremia, nausea, apathy, weakness, fatigue
Fluid and electrolyte effects of CKD - Proteinuria, hematuria, hyperkalemia - Metabolic acidosis
Cardiovascular effects of CKD - CVD leading cause of death - Accelerated atherosclerosis - Systemic hypertension - Pericarditis
Hematologic effects of CKD - Anemia - Epistaxis: nose bleeds - GI bleeding
Immune system effects of CKD - Increased risk of infection - Fever suppressed
GI effects of CKD - Anorexia, nausea, and vomiting - Hiccups, gastroenteritis frequent - Uremic fetor
Neuro effects of CKD - CNS changes - Peripheral neuropathy - Restless leg syndrome
Musculoskeletal effects of CKD - Renal osteodystrophy (rickets) - Bone tenderness, pain, fractures
Endocrine and metabolic effects of CKD - Reproductive function impaired
Derm effects of CKD - Pallor, yellowish hue to skin - Uremic frost: crystallized urea deposits on skin of pt w/CKD
Diagnostic tests for CKD – Urinalysis, urine culture – BUN, serum creatinine – eGFR – Serum electrolytes – CBC – Renal ultrasonography – Kidney biopsy
Treatment Medications for CKD – CKD affects the pharmacokinetic/pharmacodynamic effects of drug therapy. – ACE inhibitors and ARBs (angiotensin II receptor blockers) – Diuretics or other loop diuretics
Treatment Medications for CKD – Drugs to manage CV disease, electrolyte imbalances/acidosis – Folic acid and iron supplements
Nutrition and fluid management for CKD – Prevent protein-calorie malnutrition – Regulate, restrict sodium intake
Hemodialysis - Occurs in dialysis center - Usually 3 times/wk (9-12 hrs/week)
Hemodialysis - Most common therapy for ESKD. - Removes excess fluids and waste and restores chemical and electrolyte balance by passing patient’s blood through an artificial semipermeable membrane.
Post-dialysis care – Monitor vital signs and weight for pre-procedure comparison. – Avoid invasive procedures 4 to 6 hours after dialysis. – Continually monitor for hemorrhage
Post-dialysis complications – Dialysis disequilibrium syndrome – May develop after initial, rapid HD has been completed
S&S of Dialysis disequilibrium syndrome - HA, N&V, restlessness, Dec LOC, inc intracranial pressure, seizures
Post-dialysis complications - Infectious diseases – most serious: - Hepatitis B and C infections - HIV exposure—poses some risk for clients undergoing dialysis
Peritoneal Dialysis (PD) - Uses body’s own peritoneal membrane which lines the abdominal cavity as the semi-permeable membrane to filter out excess fluids and electrolytes and end-products of metabolism
Complications of PD - Peritonitis – major complication - Pain - Exit site and tunnel infections - Poor dialysate flow – re constipation - Dialysate leakage
Nursing Care During PD - Before treating, evaluate baseline VS, wt, and lab tests. - Continually monitor for respiratory distress, pain/discomfort. - Monitor prescribed dwell time and initiate outflow. - Observe the outflow amount and pattern of fluid.
Kidney transplant - Treatment of choice for patients with ESRD - Improves quality of life - Most obtained from deceased donors - Meet criteria for brain death - Less than 60 years old - Free from disease, malignancy, infection
Kidney transplant - Renal artery, vein, ureter anastomosed - Immunosuppressive drugs minimize response to reject organ. - Hypertension possible complication - Infection is a continuing threat
Health promotion for kidney transplant - Kidney disease prevention - Diabetes and hypertension management - Treatment of infections - UTI prevention - Maintenance of proper blood pressure and blood glucose levels - Hydration of patients with compromised renal function
Created by: pdimple